week10 Flashcards
What are some of the considerations of Paediatric patients
Surface area to volume ratio – heat loss/fluid loss
high glycogen stores and lower metabolic rate
Fluid requirements based on body weight
O2 delivery adjusted
What are the differences between an adult’s airway and a child’s?
Newborns larynx is 1/3rd size of adult’s Shorter maxilla and mandible
Large tongue
Floppy epiglottis
Shorter trachea
What is the difference in management of a child’s airway compared to an adult’s?
Place child in sniffing position (neutral) to prevent occlusion of airway, whilst adults head needs to be tilted back
What is the normal resp rate for a child?
40 breaths per minute
Is Tachypnoea a normal response for infants who are sick?
Yes, if their breathing slowed we would be concerned
What are common O2 delivery devices for infants?
Nasal prongs
Bipap
Headbox
What is the components of an airway/breathing assessment of a child?
Airway patency
Child talking/crying
Adventitious sounds – wheeze, stridor, grunting (bad sign ?early intubation)
What are the signs of respiratory distress in children up to 8yrs?
Head bobbing
Nasal flaring
Intercostal/sternal recession Fatigue
Croup is?
Acute swelling causing upper airway obstruction (Treat with steroids and nebulised
adrenaline)
Epiglottitis is?
Inflammation of the epiglottis (Urgent intubation – nurse upright/supported until ETT)
Foreign body aspiration is?
aspiration of anything small enough to fit in the mouth (Coughing, back blows
removal of FB with magill forceps)
Broncholitis is?
Viral obstruction of small airways resulting in air trapping (Continuous monitoring,
SP02 – supportive management)
Asthma is?
Mucosal and immune system dysfunction of the lower respiratory tract causing inflammation of the airways (asthma severity assessment, oxygenation, bronchodilation, steroids)
How is an infant/child ventilated?
ETT uncuffed
Suction every 2-6hrs
Humidify airways
What are the considerations for a child receiving ventilation?
Monitor for signs of gastric decompression
Restraint may be required (splints on elbows)
Analgesia/sedation
What pulses are checked in children?
Brachial
What is the urine output for a child?
0.5-2mls per hour
Describe the symptoms of hypovolaemic shock in children
Compensation – vasoconstriction and tachycardia (may lose up to 30% blood volume before becoming hypotensive)
Pulse pressure will narrow (before hypotension)
What are the symptoms of septic shock?
Hypoxaemia
Hyperthermia/hypothermia
Cool/mottled skin
What is the management of shock?
ABCDE assessment
Cardio respiratory monitoring/temp/urine output/ABG/U&E
Fluid resuscitation
What are some conditions which affect a child’s neurological function?
Meningitis
Encephalitis
Seizure
Encephalopathy
What are the most common causes of admission in older adults?
Arrhythmias Heart Failure Stroke Fluid & electrolyte imbalances Pneumonia Hip fractures
What are the considerations for an older adult?
Surgical risk is higher
Delirium post-surgery, sensitive to fluids
Medications and infections – high risk of infections/polypharmacy
Metabolic & nutritional imbalances
Sensitive to opioids
What are some age related changed to the older adult?
Cardiovascular – cardiac output, rate/rhythm, circulation
Respiratory – ventilation/perfusion/ventilation control and lung compliance decreased
Urinary – functioning nephrons decreased & excretion of toxins decreased
What are some reasons a patient may require intensive care?
Hypo/hypertension Respiratory compromise Cardiac arrhythmias Acute renal failure Multiple organ failure post-surgery
Circulation Physiology and pathophysiology
Children compensate for hypovolaemia by vasoconstriction and tachycardia, and may lose up to 30% of blood volume before becoming hypotensive
The pulse pressure will narrow before hypotension occurs.
Capillary refill is a non-specific sign of circulatory compromise in a hypothermic child.
Tachycardia is also non-specific, and occurs in children who are hypovolaemic, in pain, frightened, hypoxic, hypercapneic, having seizures etc. Look for the cause and treat it.
